Medicaid expansion decision looms for many states

Clues about governors’ intentions for Medicaid expansion are beginning to seep out of tight-lipped state capitals, and it may be the start of a deluge.

Most have kept silent until now, waiting for the presidential election to determine whether the Affordable Care Act — and its optional Medicaid expansion — would survive. But President Barack Obama’s reelection, combined with looming budget deadlines in all of the indecisive states, could force their hands.

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Millions of Americans’ access to health care is in the balance. Under the ACA, nearly all adults earning under 138 percent of the federal poverty level would be eligible for Medicaid in states that undertake the expansion. The early estimates that the law would get 30 million or more uninsured Americans covered were based on the assumption that all 50 states would expand their programs, insuring 16 million additional people.

Already, a handful of governors have indicated that they’ll use their state budget process to make a decision about Medicaid.

In Wyoming, Republican Gov. Matt Mead plans to make a choice by Dec. 1, when he’s due to file an update to his state’s biennial spending plan.

“He’s still concerned about the federal government’s ability to pay for expansion and concerned about what the impact of adding 30,000 people would be to Medicaid in Wyoming,” said spokesman Renny MacKay.

In Arizona, where the state already covers childless adults up to 100 percent of the FPL, a spokesman for Gov. Jan Brewer suggested she’d make a call before her budget is filed in January. Missouri’s newly reelected Democratic Gov. Jay Nixon told reporters he’ll reveal his intentions by the time he releases a budget in January. He told reporters last week that he wants to make sure expansion dollars don’t end up on the table during federal budget talks.

Of the nearly two-thirds of governors who have yet to take a firm position on Medicaid expansion, nearly all face budget-filing deadlines that range from mid-November to March — a handful of states with biennial budgets include mechanisms for updates that could reflect Medicaid expansion. That means the expansion picture could be a lot clearer before clocks spring ahead.

In Montana, outgoing Gov. Brian Schweitzer, a Democrat, is due to release his new two-year budget this week, although incoming Democratic Gov. Steve Bullock can make changes by the end of December. A Bullock spokesman said he anticipated Schweitzer would address the expansion in his budget.

Oregon Democratic Gov. John Kitzhaber’s spokesman, Tim Raphael, said, “We will be delivering our budget on Nov. 30, and we should have more [on the expansion] at that time.” Asked if he stood by his July statement that the state is “committed to continuing to expand,” he said yes.

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Readers' Comments (5)

A lot of big talk. Any Governor ho doesn t work for his citizens and get it mostly paid for out of the federal tax revenues is so hoplessly ideological he/she should be recalled. That fact is these same people get coverage in the emergency rooms and the state eats that bill.At least the state would have control over auditing who is eligible and can work to get them off it.Like I said. Big talk. In the end even the idiot republicans know how to count.

In an unusual move the AMA recently discontinued psychiatry billing codes. No more medication management code. No bundled psychotherapy plus medication management. What an interesting thing to do. If Medicaid does significantly expand the AMA has just made it harder for emotionally and behaviorally disturbed children to be seen.

No one has seen the new fee schedules for the new codes so it is impossible to determine whether psychiatrists will face a 40% revenue loss or come out about the same. What is clear is that paperwork requirements will double. And the "caring" part of psychotherapy has been devalued. Now, if a patient is doing better - the doctor will get paid less... as if the longterm relationship with the patient has no intrinsic value.

If you are concerned about this change in emotional, behavioral, and mental health care... you now have someone to call - - - your congressman. Congress has full authority over health insurance companies, hospitals, and health care practitioners. No longer will hospitals and insurance companies squash your complaints. Let your Congressman's office know about anything you don't like about the health changes underway. Health care belongs to us now - we the people.

The ACA may actually reduce access to care for our most vulnerable populations.

The 32 million newly insured will try to double their consumption of health care and middle- and upper-middle-income families will have more generous coverage than they have now, but there will be no increase in supply.